In 1993 a University of Wisconsin study, involving a cross section of middle aged men and women, produced results of 24% of the men fit the 5 apnea per hour of sleep criteria for the diagnosis of obstructive sleep apnea (OSA) and 9% of the women had OSA. Middle age was defined as between 30 to 60 years old. When the individuals were surveyed for symptoms, and they were asked if they were sleepy, 1 out of 6 men admitted to day time sleepiness. Since several years before, Dr. William C. Dement (prominent Stanford Sleep Medicine professor) had coined the diagnostic category of “sleep apnea syndrome” to include those individuals who presented to the physician with a primary complaint of day time sleepiness AND were found to have obstructive sleep apnea as the cause of this sleepiness, some authors appeared to have confusion. Hence “obstructive sleep apnea” does not equal “sleep apnea syndrome”. The textbooks began selectively quoting this research and noted that “sleep apnea syndrome” affected 4% of the men in this study and failed to include the observation that 24% of the men actually had obstructive sleep apnea. This issue confused me why some authors said 24% and others notes 4% until I came across the Psychiatric Clinics of North America article where Dr. Dement coined the expression “sleep apnea syndrome” and defined it. I also came across his research where older men who had 5 episodes of sleep apnea per hour of sleep BUT NOT 4 episodes (or less) of apnea per hour would have adverse effects from 2 (and only two )alcoholic beverages. These men would have up tp 4 times (and some authors say 5 times) as many apneas per hour of sleep with only such minimal apnea to begin with. If there was any doubt, Dr. William Powell also of Stanford published research in 1999 demonstrating that persons with mild to moderate obstructive sleep apnea were worse drivers than individuals (without sleep apnea or sleep deprivation) who were legally drunk (California commercial code .04% alcohol level).
I’ve reviewed textbooks of internal medicine and family medicine/primary care) from before 1994 through 2008. Finally, one textbook (Cecil’s) got the 1993 University of Wisconsin study accurate. In 2008 Cecil’s Textbook of Internal Medicine is the first major textbook to clarify this issue. A point I would like to make is that this was a major departure from their prior coverage and it would have been useful if they had noted this and discussed this. Meanwhile, in the face of data to the effect that approximately half of hypertension cases have OSA as a major etiology, Cecil’s coverage of arterial hypertension glosses over this. It truly is a snow job. Midway through the coverage of arterial hypertension is a chart listing different causes of secondary hypertension including OSA. Several pages prior to this chart there is a separate reference to this chart and noting that it is cost prohibitive to actually check people for these disorders.